[Symmetrical peripheral gangrene: 4 cases]. / La gangrène périphérique symétrique : à propos de 4 cas.

BACKGROUND: Symmetric peripheral gangrene (SPG) is a symmetrical distal ischemic lesion on at least 2 or more extremities in the absence of proximal arterial obstruction and vasculitis. It is a rare and severe clinical entity. The aim of this study was to describe clinical symptoms, etiological agents and the management of SPG through a series of 4 cases. PATIENTS AND METHODS: We included all cases of SPG hospitalized between 2000 and 2014. The inclusion criterion was the presence of distal ischemic damage at two or more sites in the absence of large vessel obstruction. RESULTS: Four patients (2 men and 2 women) were included. The mean age was 43.2±12 years. Two patients had a history of splenectomy. All patients had blackening of the tips of the fingers and toes. Three patients presented with septic shock. The etiology was bacteremia involving Streptococcus pneumoniae in two cases and a malignant form of Mediterranean spotted fever (MSF). In addition to specific antibiotics, we used a potent vasodilator (iloprost) in two cases and curative heparin therapy in two cases. The outcome was favorable in 3 cases, with regression of necrotic lesions. One case required the amputation of non-perfused necrotic fingers and toes. CONCLUSION: SPG can complicate MSF in some rare cases. Thorough and repeated skin examinations are essential to ensure timely diagnosis and treatment of GPS in order to improve the prognosis.

A new simplex chemometric approach to identify olive oil blends with potentially high traceability.

Olive oil blends (OOBs) are complex matrices combining different cultivars at variable proportions. Although qualitative determinations of OOBs have been subjected to several chemometric works, quantitative evaluations of their contents remain poorly developed because of traceability difficulties concerning co-occurring cultivars. Around this question, we recently published an original simplex approach helping to develop predictive models of the proportions of co-occurring cultivars from chemical profiles of resulting blends (Semmar & Artaud, 2015). Beyond predictive model construction and validation, this paper presents an extension based on prediction errors' analysis to statistically define the blends with the highest predictability among all the possible ones that can be made by mixing cultivars at different proportions. This provides an interesting way to identify a priori labeled commercial products with potentially high traceability taking into account the natural chemical variability of different constitutive cultivars.

Authentication of Tunisian virgin olive oils by chemometric analysis of fatty acid compositions and NIR spectra. Comparison with Maghrebian and French virgin olive oils.

Six Tunisian virgin olive oil (VOO) varieties, Chemlali Sfax, Chetoui, Chemchali, Oueslati, Zarrazi and Zalmati, were characterised by two analytical methods. The gas chromatography allowed the determination of 14 fatty acids and squalene amounts. With fatty acids of each variety, a characteristic "morphotypes" for each oil variety was established. Chemlali Sfax and Zalmati showed strong similarities. Gas chromatography of fatty acid methyl esters (FAME) and near infrared (NIR) spectra of oils, associated to chemometric treatment, allowed the study of the inter-varietal variability and the verification of the variety origins of some Tunisian commercial VOOs. The specificity of Tunisian VOOs was evaluated by comparing the samples to Algerian, Moroccan and French Protected Designation of Origin VOOs. Classification in varietal origins by SIMCA used the FAME compositions and NIR spectra of the most represented varieties (Chemlali Sfax, Chetoui and Oueslati) showed a high potential to authenticate the varietal origin of Tunisian VOOs.

[MR imaging features of tuberculosis of the sellar region]. / Aspects IRM de la tuberculose de la région sellaire.

PURPOSE: Tuberculosis of the sellar region, especially the pituitary gland, is rare. The purpose of this article is to demonstrate through a review of five clinical cases the value of imaging, especially MR imaging, in the evaluation of this pathology. PATIENTS AND METHODS: CT and MRI of the brain were obtained in all cases along with a chest radiograph. RESULTS: Four patterns were detected on MRI: pituitary tuberculoma mimicking adenoma; pituitary abscess, extending to the cavernous sinus in one case and associated with infundibulum thickening in another; hypophysitis with suprasellar extension in association with tuberculous meningoencephalitis; and infundibular thickening associated with tuberculous meningoencephalitis. Diagnosis was based on biopsy in two cases and combination of imaging and clinical data in three cases. Outcome was favorable with anti-tuberculosis drugs. CONCLUSION: Irrespective of the imaging features, a history of travel to an endemic region combined to other findings such as infundibular thickening should raise concern for the possibility of tuberculosis even in the absence of signs of systemic infection.

[Varicella pneumonia: a serious complication of varicella in adults]. / La pneumonie varicelleuse: une complication grave de la varicelle chez l'adulte.

Pneumonia caused by varicella infection is a serious and severe complication of the disease when it occurs in adults. The authors report two cases of a varicella pneumonia in a 36 and a 41 year-old non-immunocompromised man. They were admitted to hospital for acute respiratory failure, not requiring intensive care, associated with exanthema. High resolution CT revealed well-defined diffuse nodules throughout both lungs, nodules with a surrounding halo of ground-glass opacity. Thrombocytopenia, hepatic cytolysis and an increase in lacticodeshydrogenase were noted. The patients made a full recovery with anti-viral therapy and oxygen therapy. Varicella pneumonia is the most common complication of varicella in adults. Anti-viral treatment is usually successful.

Childhood dermatomycoses study in Sfax Hospital, Tunisia.

Mycoses are frequent affections in childhood. Fungal type varies according to the age and the affected organ. The aim of this study was to determine the aetiological agents of childhood dermatomycoses and to draw attention to the diversity of their clinical manifestations. Retrospective study dealing with children's cases with age <16-year old and having dermatomycosis diagnosed between 1991 and 2005 at the Parasitology and Mycology Laboratory of Sfax University Hospital. A total of 4559 children suspected to have superficial mycoses were examined. Dermatomycosis diagnosis was confirmed in 49.3% of cases. Dermatophytes were the most prevalent fungal agents and accounted for 1865 cases (80.6%) dominated by Trichophyton violaceum (54.1%) and Microsporum canis (24.5%). Tinea capitis (69.4%) was the most common type of infection, followed by tinea corporis (20%). Superficial yeast infections (442 cases) were dominated by Malassezia infections (71%). Candida infections were mainly due to Candida albicans (58%). The clinical features of paediatric dermatomycoses vary with the age of the children: tinea capitis and tinea corporis were more frequent before 13 years of age. After this age, tinea versicolor and onychomycoses became more common.

[Resistance to third generation cephalosporins in Sfax hospitals, Tunisia (1999-2005)]. / Etude de la résistance des entérobactéries aux céphalosporines de troisième génération dans les hôpitaux de Sfax, Tunisie (1999-2005).

OBJECTIVES: The authors wanted to assess the prevalence and to monitor the trends of resistance to broad-spectrum cephalosporins among various species of enterobacteria in the region of Sfax (Tunisia). METHODS: A retrospective study was carried out in the microbiology laboratory at the Habib-Bourguiba Teaching Hospital in Sfax. Data concerning a seven-year period (1999-2005) were analyzed with the Whonet 5.4 software. All clinical isolates of enterobacteria were identified with the API 20 E system. Antimicrobial susceptibilities were determined by disk diffusion on Mueller Hinton agar according to CA-SFM recommendations. RESULTS: During the study period, 24,702 non-duplicate clinical strains of enterobacteria were identified. Fifteen percent (3,826) clinical isolates showed acquired resistance to third generation cephalosporins (3rdGC). The overall frequency of resistance increased from 10% in 1999 to 18% in 2005. This increase was statistically significant. High prevalence rates of 3rdGC resistance have been observed in intensive care units (48%), hematology and oncology wards (27%) and pediatric wards (25%). Klebsiella pneumoniae, Indole positive Proteus and Enterobacter showed high prevalence rates of broad-spectrum cephalosporin resistance. CONCLUSION: This study revealed a high rate of 3rdGC resistance enterobacteria in our region, particularly in intensive care units. The frequency of acquired resistance to broad-spectrum cephalosporins seemed to be increasing. Implementation of infection control measures and identification of the mechanism responsible for third generation cephalosporins resistance are necessary to limit the spreading of these resistant enterobacteria in hospitals and community settings.

[Tuberculous pneumothorax. Retrospective study of 23 cases in Tunisia]. / Le pneumothorax tuberculeux. Etude rétrospective de 23 cas à l'Hôpital Farhat-Hached de Sousse, Tunisie.

The tubercular pneumothorax is a rare and severe form of tuberculosis which persists in Tunisia. We reviewed retrospectively our experience at the Pneumology-Allergology Department of the Sousse Hospital with 23 cases of tubercular pneumothorax observed between 1985 and 2003. The suggestive symptom, pneumothorax, always occurred within a context poor general health and fever. The chest roentgengraph showed pneumothorax (n=8) or hydropneumothorax (n=15), and pulmonary lesions associated in 82.5% of patients. Bacteriological proof was obtained in 21 cases; in the two other patients, histological examination of the surgical specimen was highly suggestive of tuberculosis. Treatment associated antitubercular chemotherapy in compliance with the National Plan of against Tuberculosis (n=23), chest drainage (n=21) and respiratory physiotherapy (n=18). Five patients underwent surgery: pleural decortications (n=3), pulmonary resections (n=2). Two were lost to follow-up. The course was favourable in 78% of patients; there were two cases of partitioned pyopneumothorax and one post-operative death. In our experience, tubercular pneumothorax was always associated with active cavitated tuberculosis. The course was almost favorable with antitubercular chemotherapy and chest drainage.

[Bacteriological profile of infectious endocarditis in the area of Sfax (Tunisia)]. / Profil bactériologique des endocardites infectieuses dans la region de Sfax (Tunisie).

We performed a study to analyze epidemiological characteristics and bacteriological profile of infectious endocarditis (I.E) in the area of Sfax (Tunisia). We analyzed, retrospectively, all cases of I.E, according to Duke Criteria, hospitalized in the CHU Hédi Chaker of Sfax between January 1997 and December 2000. Bacteriological investigation included blood culture, cardiac valve culture and serology. Seventy-two cases of I.E were diagnosed. The average of age was 32.3 years. 47.3% of the patients did not have cardiac disease, 25% had a valvular prosthesis, 20.8% a native valvulopathy and 6.9% a congenital cardiopathy. Antecedent of acute rheumatic fever was noted in 66% of I.E on native valvulopathy and in 55.5% of I.E on prosthesis. The mitral valve was involved in 39%, the aortic in 27.5% and the two in 26% of the cases. The origin of bacteremia was found or supposed in 55.5% of the cases and was commonly dental (33 % of EI). The bacteriological diagnosis was positive in 51 cases (70.8%). Staphylococci were isolated in 17 cases (23.6%), Streptococci in 17 cases (23.6%) and dominated by oral streptococci (12 cases). Chlamydial serology was positive in 8 cases (11.1%). Diagnosis of infectious endocarditis due to Chlamydia pneumoniae was confirmed in a case by genomic amplification (PCR) and in situ hybridization on the valve. Endocarditis in Tunisia remains frequent. It reaches with predilection the young person in particular with rheumatic heart diseases. The bacteriological profile remains dominated by Streptococci and the Staphylococci.

[Recurrent spontaneous pneumothorax complicating osteosarcoma pulmonary metastasis]. / Un pneumothorax spontané récidivant compliquant les métastases pulmonaires d'un ostéosarcome.

We report the case of a 15-year-old girl with osteosarcoma in the left distal femur who developed a recurrent spontaneous pneumothorax. The patient was treated by neoadjuvant chemotherapy followed by surgery (limb-sparing surgical procedure with insertion of a knee prosthesis) and then adjuvant chemotherapy. The initial extension assessment was normal. No pulmonary metastasis was found. The chest tomography performed at the end of treatment (8 months after surgery) revealed two peripheral pulmonary nodules not seen on the chest X-ray. Palliative chemotherapy was given, the thoracic tomography after four chemotherapy courses showed a progress of the pulmonary metastasis and on the right more abundant bilateral pneumothorax which had recurred two months after thoracic draining. Thoracoscopy showed no pleural lesions.

[Large bilateral lung opacities]. / Volumineuses opacités pulmonaires bilatérales.

We report the case of a 42-year-old woman operated for neurofibroma of the scalp on two occasions who consulted for bilateral chest pain which reveated two voluminous bilateral pulmonary masses. Biopsy of one of these masses was in favor of secondary or primary leiomyosarcoma. The association of Von Recklinghausen's disease and soft tissue sarcoma is rare: most often neurofibroma which degenerates is observed. Other types of sarcoma, like leiomyosarcoma, have been described.

[Skin test reactivity to seven aeroallergens in a Sousse area population sample]. / Sensibilisation cutanee aux pneumallergenes courants dans une population generale de la region de Sousse.

INTRODUCTION: Allergy skin tests are an important tool in the diagnosis of allergy diseases. They are useful in epidemiologic studies. OBJECTIVES: The aim of our study is to estimate the prevalence of the skin sensitivity in a sample of unselected population and to study the relationship between skin test reactivity and clinical manifestations. PATIENTS AND METHODS: During 9 months, we undertake skin prick-test in 500 subjects. Our population was recruited in the blood sample room of the biochemistry laboratory of the University Hospital of Sousse. Seven aeroallergen was tested: Dermatophagoïdes pteronyssinus (DPT), Dermatophagoïdes farinae (DF), Pollens of Graminees, Olive-tree, Partetaure, Cockroach and Candidine. A positive and a negative control tests were made. RESULTS: 34% of the population was sensitized to one or more aeroallergens. In the litterature this prevalence vary from 9 to 55.5% according to the methodology applied. In our study the skin reactivity does not change with sex (p = 0.26) but was high in subjects aged between 15 and 35 years. 21.8% were sensitized to house dust mites (DPT, DF) and 18.2% to pollens (Olive-tree, Graminees, Parietaire). Skin reactivity was more common when subjects had personal atopic history (p < 0.003) and/or had actual allergic symptoms particularyrhinitis and asthma (p < 0.006). CONCLUSION: Skin reactivity to common aeroallergens is frequent in the general population, particularly in symptomatic subjects affected by rhinitis and/or allergic asthma. This skin sensitization is the result of genetic and environmental interaction, but skin sensitization does not mean allergy.

Imaging of retroperitoneal ganglioneuroma.

The aim of this study was to describe the radiological appearance of retroperitoneal ganglioneuroma. We retrospectively reviewed seven cases of histologically proven retroperitoneal ganglioneuroma. Ultrasound and enhanced CT were obtained in all cases, and MRI in three cases. The masses were well-circumscribed, ranged in size from 5 x 3 x 3 to 10 x 6 x 4 cm. In three cases close relationships between the tumor mass and major blood vessels were noted, resulting in vessel displacement or surrounding, but without compression or occlusion. On ultrasound examination the tumor showed a heterogeneous solid echostructure. Non-enhanced CT showed homogeneous or mildly heterogeneous low attenuation, and a punctate calcification was seen in one case. Contrast uptake was absent (n = 1) or delayed (n = 6). Progressive but incomplete enhancement was observed in three cases. On MRI, T2-weighted images showed a high signal intensity. Dynamic studies depicted the same enhancement pattern as described on CT. Ganglioneuroma is a rare tumor which should nevertheless be included in differential diagnosis of retroperitoneal masses when presenting as a well-delimited tumor with possible tendency to surround or displace major blood vessels, low density on non-enhanced CT, and delayed progressive enhancement on CT and MRI.

[Trans-ethmoid encephaloceles]. / Les céphalocèles transethmoïdales.

We report two cases of ethmoidal cephaloceles. Ethmoidal cephaloceles are very rare and most commonly present with recurrent episodes of meningitis or sometimes as a nasal mass. Diagnosis is made at MR and CT. Such imaging studies should be obtained in patients with recurrent meningitis or patients with polypoid nasal lesions prior to biopsy.

Imaging features of uncommon adrenal masses with histopathologic correlation.

Uncommon adrenal masses include cystic lesions (hydatid cyst, endothelial cyst), solid lesions (hemangioma, ganglioneuroma, angiosarcoma, primary malignant melanoma), and solid fatty lesions (myelolipoma, collision tumor). Most of these lesions do not have specific imaging features. The liquid content of adrenal cysts is clearly demonstrated on ultrasonographic scans, computed tomographic scans, and magnetic resonance images. Nevertheless, the histologic type cannot be predicted except at some stages of hydatid disease in which pathognomonic features are present. The most typical imaging features of hemangioma are phleboliths and enhancement of peripheral vascular lakes. Ganglioneuroma has nonspecific radiologic features, but this diagnosis should be considered in cases with early enhancement of fine septa and progressive filling. The radiologic features of angiosarcoma and primary malignant melanoma are nonspecific. A macroscopic lipid content within an adrenal mass is theoretically characteristic of myelolipoma. This diagnosis should be made with caution, especially when the lipid content is not predominant, because of the possible association with an adenoma.

[Influenza and asthma]. / Grippe et asthme.

The relationship between infections of the respiratory tract and exacerbations of pulmonary symptoms in individuals with asthma is well established on clinical grounds. Patients having an acute attack of asthma often give a history of a "cold" before the onset of the exacerbation. The identification rate of viruses during exacerbations of asthma (10-30%) is much higher than the viral identification rate generally found during asymptomatic periods in asthmatics (3%). The mechanisms whereby upper respiratory viruses might induce or contribute to attacks of asthma are currently unknown: epithelial damage, increased cytokines releasability, mouth breathing.... Influenza vaccination is recommended in patients with chronic pulmonary diseases. However, bronchial hyperreactivity has been reported after influenza vaccination in asthmatics. Reactions to these vaccines may be due to non-immunogenic impurities, which are not present in the more recently developed subunit vaccines. In spite of the lack of double-blind studies between subunit and killed influenza virus vaccines, and because of the potential bad prognosis of influenza infection on airway obstruction, influenza vaccination should be recommended in asthmatics with stable respiratory function but influenza vaccination rate remains low.

[Primary intraosseous meningioma of the vault]. / Méningiome intra-osseux primitif de la voûte.

Primitive intra-osseous meningioma is a rare benign tumor. We report a case with a temporal localization and antro-attical extension into the petrous bone.